My Buddy In Radiology Said The Job Market Is A Disaster: True?

[Coastie]

I've got a friend from med school who is looking to graduate this upcoming year from radiology.

He told me that the market is a disaster. He has no fellowship, and can't find a job.

He reports that previous graduates who are now finishing fellowships are running into the same thing.

He is in the southeast..Is he simply not looking far enough, is he an idiot, or is he spot on?

Thanks in advance for responses.

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[C5toC9]

how are resident graduates selected for jobs anyway? just based on school name and interview?

 

[colbgw02]

The job market is certainly tighter than it was a few years ago. Like with most things, you will not be able to get everything you want - salary, lifestyle, location. I suspect that if your friend were willing to go to a rural area, particularly in the midwest or some of the Rocky Mountain states, that he'd find a job quite easily.

These things are cyclical. Eventually, the economy will recover, as will the 401(k)s of thousands of aging radiologists. They'll subsequently retire, and the job market will open up again. Being in radiology remains a great place to be overall, and most of the people predicting the end of radiology as we know it are misinformed.

 

[FadingPromise]

Being in radiology remains a great place to be overall, and most of the people predicting the end of radiology as we know it are misinformed.

The most interesting part is that radiology is typically the most commonly tauted as the "dying specialty" by non-radiologists. I sometimes wonder if this is just the envy/bitterness over the imagined life style and compensation, but I always see so many people with these concerns because their IM attending/surgery residents tell them all the horror stories about outsourcing, etc...it is almost as if they wish radiology will die in this country.

 

[Coastie]

The most interesting part is that radiology is typically the most commonly tauted as the "dying specialty" by non-radiologists. I sometimes wonder if this is just the envy/bitterness over the imagined life style and compensation, but I always see so many people with these concerns because their IM attending/surgery residents tell them all the horror stories about outsourcing, etc...it is almost as if they wish radiology will die in this country.

I hope for my buddy's sake that it isn't dying....

I'll tell him to look more broadly, but I imagine he's already done some of that.

 

[vicinihil]

surgeons WOULD say something like that. They work 2x as much for less pay.

 

[C5toC9]

why do radiologists get paid more for less work?

 

[colbgw02]

why do radiologists get paid more for less work?

Obvious troll is obvious.

 

[colbgw02]

The most interesting part is that radiology is typically the most commonly tauted as the "dying specialty" by non-radiologists. I sometimes wonder if this is just the envy/bitterness over the imagined life style and compensation, but I always see so many people with these concerns because their IM attending/surgery residents tell them all the horror stories about outsourcing, etc...it is almost as if they wish radiology will die in this country.

I often think that radiology is the least well understood specialty in medicine, and I wonder if your observation falls under that phenomenon. I'm constantly amazed at how little other physicians understand about not just the substance of radiology, but also its workflow, reimbursement, credentialing, etc. When people say that radiology will be outsourced, I suspect it stems from ignorance rather than malice.

 

[C5toC9]

Lol, I'm not a troll, but I am a naive preclinical med student who honestly doesn't understand why and how the salary levels are the way they are. Any honest responses would be appreciated.

 

[colbgw02]

Lol, I'm not a troll, but I am a naive preclinical med student who honestly doesn't understand why and how the salary levels are the way they are. Any honest responses would be appreciated.

I apologize. It's easy to forget how much I didn't know. The bottom line is this: when comparing specialties, work - however you care to quantify it - correlates with reimbursement very loosely.

You would be hard-pressed to find a general pediatrician who works 100 hours/week and makes more money than a radiation oncologist who works 35 hours/week. It's not right; it's not fair, but that's the way it is. A specialty that is procedure-oriented will tend to have higher reimbursement, and for purposes of this discussion, imaging studies are considered procedures.

With the use of PACS systems and voice-recognition software, the throughput of radiologists has increased dramatically. A surgeon, on the other hand, can only do so many operations in one day no matter how quickly he works. That explains why radiologists can get paid more for working fewer hours. Does that mean that radiologists are doing less work? I don't know. You could easily argue that in terms of total benefit, the radiologist is doing more by reading so many studies.

 

[bronx43]

The most interesting part is that radiology is typically the most commonly tauted as the "dying specialty" by non-radiologists. I sometimes wonder if this is just the envy/bitterness over the imagined life style and compensation, but I always see so many people with these concerns because their IM attending/surgery residents tell them all the horror stories about outsourcing, etc...it is almost as if they wish radiology will die in this country.

The outsourcing fear is unfounded for sure, but that doesn't mean radiology isn't going to get hit by a freight train when reimbursement for diagnostic imaging gets cut - not a question of whether or not it will happen at this point. Radiology won't ever be a dying field due to its status as a staple of western medicine, but it certainly won't remain as lucrative as it currently is. And if that's what dying is, then so be it.

 

[bronx43]

You would be hard-pressed to find a general pediatrician who works 100 hours/week and makes more money than a radiation oncologist who works 35 hours/week. It's not right; it's not fair, but that's the way it is. A specialty that is procedure-oriented will tend to have higher reimbursement, and for purposes of this discussion, imaging studies are considered procedures.

Ah, rad oncs. Another one of those fields where if their salary were a stock, I would short sell it on the way to infinite riches.

 

[MossPoh]

I often think that radiology is the least well understood specialty in medicine, and I wonder if your observation falls under that phenomenon. I'm constantly amazed at how little other physicians understand about not just the substance of radiology, but also its workflow, reimbursement, credentialing, etc. When people say that radiology will be outsourced, I suspect it stems from ignorance rather than malice.

I'd go with PM&R, but rads is up there for sure. 😛

 

[Cliff Huxtable]

The outsourcing fear is unfounded for sure, but that doesn't mean radiology isn't going to get hit by a freight train when reimbursement for diagnostic imaging gets cut - not a question of whether or not it will happen at this point. Radiology won't ever be a dying field due to its status as a staple of western medicine, but it certainly won't remain as lucrative as it currently is. And if that's what dying is, then so be it.

Everyone talks about the fields that are going to get hit hard but no one ever mentions any fields that will benefit.

Anyone think that with the lack of interest in fields such as Family Practice and the eventual shortage of docs in those fields, that the law of supply and demand will increase their salary?

Or do you think that with the increasing number of med school students but stagnant number of residency spots each year, everything will stay the same since people will be "forced" to match into less competitive fields?

 

[drowsy12]

Ah, rad oncs. Another one of those fields where if their salary were a stock, I would short sell it on the way to infinite riches.

what does this mean

 

[bronx43]

Everyone talks about the fields that are going to get hit hard but no one ever mentions any fields that will benefit.

Anyone think that with the lack of interest in fields such as Family Practice and the eventual shortage of docs in those fields, that the law of supply and demand will increase their salary?

Or do you think that with the increasing number of med school students but stagnant number of residency spots each year, everything will stay the same since people will be "forced" to match into less competitive fields?

In reality, supply and demand would never affect the actual distribution of physician with respect to fields for the reason you just stated. When entering medical school matriculants equals the number of graduating physicians, it doesn't really matter how they play musical chairs in the mean time.

The real reason for lucrative specialties getting cut is just the government wanting to cut Medicare costs. The biggest target, thus, is diagnostic imaging, which is heavily used in clinical medicine. After that, they'll probably set their sights on other highly reimbursed procedures - like those by rad oncs, and maybe orthos.

As for which specialties will benefit, I think primary care specialties will benefit. There will probably be small increases in primary care reimbursement rates, but these won't be anything substantial. All you need to do to drive people into primary care is to drop the reimbursement rates of other specialties. (of course doing this won't exactly correct the maldistribution of providers we currently experience)

 

[bronx43]

what does this mean

It means rad onc reimbursement will decrease.

 

[fun8stuff]

Everyone talks about the fields that are going to get hit hard but no one ever mentions any fields that will benefit.

Anyone think that with the lack of interest in fields such as Family Practice and the eventual shortage of docs in those fields, that the law of supply and demand will increase their salary?

Or do you think that with the increasing number of med school students but stagnant number of residency spots each year, everything will stay the same since people will be "forced" to match into less competitive fields?

The shortage of outpatient primary care docs will be primarily filled by nurse practitioners and physician assistants who can do the same job for much cheaper. General IM docs will work primarily as hospitalists and be paid slightly better (as is already the case now). Family med docs will do scut/paper work and supervise the NPs and PAs.

 

[drowsy12]

do rad oncs even get paid much? like other specialties its hard to get a real idea of what kind of jobs are out there. its hard to find actual salaries on job sites, but i have seen a few and they have been in the 150 to 200 range. great pay, but not what bronx is talking about. maybe im wrong about these salaries?

 

[colbgw02]

do rad oncs even get paid much? like other specialties its hard to get a real idea of what kind of jobs are out there. its hard to find actual salaries on job sites, but i have seen a few and they have been in the 150 to 200 range. great pay, but not what bronx is talking about. maybe im wrong about these salaries?

I think so. I don't think it's uncommon for a rad onc doc to make over $1M a year - at least for now. I remember somebody telling me that the starting salary was around $700K as well, but - as you've mentioned - it's really hard to verify those numbers.

 

[bronx43]

do rad oncs even get paid much? like other specialties its hard to get a real idea of what kind of jobs are out there. its hard to find actual salaries on job sites, but i have seen a few and they have been in the 150 to 200 range. great pay, but not what bronx is talking about. maybe im wrong about these salaries?

http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

It's pretty common knowledge that they bank.

 

[avatarftw]

I don't know, the numbers look a little high. The diagnostic radiology median was 438,000 and the starting compensation was 390,000. I know a lot of radiologists and they say that nationally, the average is about 350-400,000 per year. Maybe the survey that you posted is only for full time (40+ hours/week) radiologists?


Diagnostic Radiology - Non-Interventional 438,115 $390,000

http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

It's pretty common knowledge that they bank.

 

[abcabc1]

The job market is certainly tighter than it was a few years ago. Like with most things, you will not be able to get everything you want - salary, lifestyle, location. I suspect that if your friend were willing to go to a rural area, particularly in the midwest or some of the Rocky Mountain states, that he'd find a job quite easily.

These things are cyclical. Eventually, the economy will recover, as will the 401(k)s of thousands of aging radiologists. They'll subsequently retire, and the job market will open up again. Being in radiology remains a great place to be overall, and most of the people predicting the end of radiology as we know it are misinformed.

I agree here, for the most part. That said, I don't see the Economy improving anytime soon, in light of the fact that those who set public policy are implementing policies aimed squarely at destroying the Economy. Between the drilling moratorium, finreg, tax hikes, Healthcare, Cap and Trade (which, hopefully, not pass), DC is doing everything it can to prevent an Economic recovery.

I also don't think Radiology will be disappear, or be as heavily outsourced as many others fear. Anecdotally, I've heard that postponed retirements hurt the Anesthesia job market as well.

 

[PharmaTope]

I think so. I don't think it's uncommon for a rad onc doc to make over $1M a year - at least for now. I remember somebody telling me that the starting salary was around $700K as well, but - as you've mentioned - it's really hard to verify those numbers.

i saw starting salary of $350,000 just by doing a search a few minutes ago.

 

[colbgw02]

i saw starting salary of $350,000 just by doing a search a few minutes ago.

Online salary figures are notoriously inaccurate.

 

[gonogo]

The main problem for radiology in the future isn't necessarily the decrease in reimbursements, is actually the turf battles with other clinicians. With the increase in high quality imaging, more clinicians are reading their films. Orthopods don't even read the radiologist's report, neither do neurosurgeons. In fact, both orthopods and neurosurgeons can easily lecture radiologists on msk and neuro films, respectively. Although not to the same degree, many other clinicians read their own films, not to mention cardiologists who already do their own studies. And part of the problem has to do with the way radiology residency is set up. The current training has become too outdated and ignores the high degree of subspecialization in today's medicine. A good thing is that the new model that's starting to be implemented will try to educate more subspecialized radiologists. But even so it may fall short. A radiology resident has to basically learn everything (from bone to neuro, from ob/gyn ultrasound to cardiac imaging, etc...) and by doing so doesn't master any specialty as the clinicians do. So I think this issue really needs to be addressed and residency training needs to be more subspecialized. Any comments are welcome.

 

[bronx43]

The main problem for radiology in the future isn't necessarily the decrease in reimbursements, is actually the turf battles with other clinicians. With the increase in high quality imaging, more clinicians are reading their films. Orthopods don't even read the radiologist's report, neither do neurosurgeons. In fact, both orthopods and neurosurgeons can easily lecture radiologists on msk and neuro films, respectively. Although not to the same degree, many other clinicians read their own films, not to mention cardiologists who already do their own studies. And part of the problem has to do with the way radiology residency is set up. The current training has become too outdated and ignores the high degree of subspecialization in today's medicine. A good thing is that the new model that's starting to be implemented will try to educate more subspecialized radiologists. But even so it may fall short. A radiology resident has to basically learn everything (from bone to neuro, from ob/gyn ultrasound to cardiac imaging, etc...) and by doing so doesn't master any specialty as the clinicians do. So I think this issue really needs to be addressed and residency training needs to be more subspecialized. Any comments are welcome.

Turf wars might affect radiology to some extent, but I highly doubt it'll ever put the nail in the coffin. Orthos and neurosurg might try to read their own images, but I think at the end of the day, they'll still want to consult the radiologist to cover their butt. But, all in all, I think threats to radiology include a little bit of both - cut reimbursement AND turf wars. Even then, I think their future is brighter than that of the rad onc.

 

[C5toC9]

This is something I don't understand about radiology. In rads residency, you go through all the different radiology departments and are expected to become proficient in all of them. Sometimes, you do a fellowship and then would eventually practice mostly in that subset of radiology. However, you still float around and cover different services. So you are expected to know everything, but then become an expert in one subset? It seems like a paradox to me. As the attending, you still sign off as if you are the expert even though you might not be fellowship-trained for that service? So what is the point of doing the fellowship? What is the purpose of subspecialization if you actually need to know everything about everything in radiology anyway because you float around?

 

[drowsy12]

Online salary figures are notoriously inaccurate.

well usually they are too high, you are saying that this figure is too low and that 700 k starting is more reasonable? come on

 

[colbgw02]

well usually they are too high, you are saying that this figure is too low and that 700 k starting is more reasonable? come on

actually, what i said was that someone told me $700K was reasonable (your word). that person was a radiation oncologist. of course, he could be wrong, but i trust him more so than a google search.

ETA: I make the distinction because I'm not trying to pass myself off as being authoritative, but just that I trust the first-hand information that I got more.

 

[gonogo]

This is something I don't understand about radiology. In rads residency, you go through all the different radiology departments and are expected to become proficient in all of them. Sometimes, you do a fellowship and then would eventually practice mostly in that subset of radiology. However, you still float around and cover different services. So you are expected to know everything, but then become an expert in one subset? It seems like a paradox to me. As the attending, you still sign off as if you are the expert even though you might not be fellowship-trained for that service? So what is the point of doing the fellowship? What is the purpose of subspecialization if you actually need to know everything about everything in radiology anyway because you float around?

In most academic centers most radiologists only read their subspecialty. In PP however you're expected to read everything.

 

[DocNickRiviera]

Just a quick point, I don't know if you're a rads resident or not, but do you really think voice recognition has improved throughput? I think I waste a couple hours every day dealing with craptacular voice recognition software.

 

[C5toC9]

I know of some academic centers where the radiologist primarily reads his subspecialty but also reads other studies depending on the schedule. Anyway, the confusion is still there. What is the point of fellowships if PPs are expected to be proficient in all studies? I guess I don't really understand the structure of radiology training.

 

[Cliff Huxtable]

How necessary is it to do a fellowship?

 

[Shifty B]

Just a quick point, I don't know if you're a rads resident or not, but do you really think voice recognition has improved throughput? I think I waste a couple hours every day dealing with craptacular voice recognition software.

Voice recognition increases profit because the costs are decreased. You no longer have to pay a transcriptionist and you increase your turnaround times. You also may speed up your proofreading because you don't have to go back hours later and re-read your reports to sign them. It may not directly increase your throughput though.

What does improve your throughput? PACS. Films used to be hung on these crazy lightboxes, where a tech would spend hours hanging them, you'd have to go looking for the film. The films would have to be taken down. You'd go to the film room to get a comparison... etc. Now the study and comparison just pops up. Much faster.

 

[fun8stuff]

I know of some academic centers where the radiologist primarily reads his subspecialty but also reads other studies depending on the schedule. Anyway, the confusion is still there. What is the point of fellowships if PPs are expected to be proficient in all studies? I guess I don't really understand the structure of radiology training.

I think the thought is that a group could be composed of rads with fellowship training in all areas and while they all read everything, the tough cases (or if 1 rad has a question on a case) they can consult the rad who is expert in that area. So all rads should be able to recognize things like pneumothorax, subarachnoid hemorrhage, appendicitis... but if one rad has a question on a bone tumor study or interstitial lung disease, then they could get help from the MSK or chest rad. At least, this is the way it already works at the academic center where I am doing my residency.

The worry is that ortho docs, pulmonologists, neurologists, etc are better at reading their own studies and general radiologists reading those studies do not have much to offer in terms of an interpretation. Sure, they can churn out a high number of reports and free up the clinicians time, but that isn't good enough if they the reports are full of hedging and just stating the obvious.

 

[APDoc]

I can tell you that as a current pain fellow, I look at a lot of spine MRI/CT/plain films that are under-read by a lot of radiologists. They might note the big metastasis sitting in the middle of a vertebral body that caused a compression fracture, but otherwise they like to say "Degenerative changes" and that's about it.

The docs I train with and myself always look at our own images in clinic. We never look at the reports anymore.

 

[OHMAN0125]

I can tell you that as a current pain fellow, I look at a lot of spine MRI/CT/plain films that are under-read by a lot of radiologists. They might note the big metastasis sitting in the middle of a vertebral body that caused a compression fracture, but otherwise they like to say "Degenerative changes" and that's about it.

The docs I train with and myself always look at our own images in clinic. We never look at the reports anymore.

Or you and ur buddies could be over-reading them as well. Just saying things aren't always black and white. Surgeons like to cut so they want to see findings on imaging. You guys like to do procedures .... so u get what i'm saying.

 

[bronx43]

Or you and ur buddies could be over-reading them as well. Just saying things aren't always black and white. Surgeons like to cut so they want to see findings on imaging. You guys like to do procedures .... so u get what i'm saying.

I think his point was more that for him, radiologists provide a largely redundant and ultimately value-less service. Many attendings I've spoken to echo his sentiments.

 

[C5toC9]

It seems to me that 90% of the dictated report is not clinically useful anyway (eg. measurements WNL, etc). Docs skip to the impressions and question.

 

[PharmaTope]

Online salary figures are notoriously inaccurate.

this was a job posting not a salary quote.

local place was looking for radiologist and gave salary range 🙂

 

[penguin24]

It seems to me that 90% of the dictated report is not clinically useful anyway (eg. measurements WNL, etc). Docs skip to the impressions and question.

90% of any specialty's dictated report is not clinically usefull. Does this ring a bell:

HEENT: NCAT, EOMI
CV: RRR, S1 & S2 present, no g/m/r
Resp: CTAB no w/r/r
GI: soft, NT, ND, BS present, no rebound/gaurding
Ext: no c/c/e

In this case docs would skip to the assessment & plan

 

[marcus pupil]

I can tell you that as a current pain fellow, I look at a lot of spine MRI/CT/plain films that are under-read by a lot of radiologists. They might note the big metastasis sitting in the middle of a vertebral body that caused a compression fracture, but otherwise they like to say "Degenerative changes" and that's about it.

The docs I train with and myself always look at our own images in clinic. We never look at the reports anymore.

Well I am glad you are an expert in reading your own films against a person who was specifically trained to read them. It is funny, when I was an intern rotating thru neurosurg, the surgeon used to complain about the inadequacies of the studies yet he read each one. If you told me that a patient was having left sided back pain, and I was reading the mri, i will comment specifically that , yes, this patient has left sided neuroforaminal stenosis at l4-l5 and suggest that this could be the reason for the pain. But if you order a report and all you put is a vague symptom like general back pain (which a lot of you do), then i wll look at the image, noting several levels of degenerative changes and say " multiple levels of degenerative changes noted"..because degenerative changes do cause back pain. If you want to get a more accurate report TELL US WHAT SPECIFICALLY YOU ARE CONCERNED ABOUT'". dont send us a blind study. just like you get history from the patient when you are consulted, we need a history too. imagine if a person walked into the door and the ER doc said HISTORY: SICK, and tells you to admit the patient with no history. yes you might catch the obvious diseases(with labs, PE etc), but a lot of times, the history helps direct you.

my 2 cents

 

[APDoc]

Well I am glad you are an expert in reading your own films against a person who was specifically trained to read them. It is funny, when I was an intern rotating thru neurosurg, the surgeon used to complain about the inadequacies of the studies yet he read each one. If you told me that a patient was having left sided back pain, and I was reading the mri, i will comment specifically that , yes, this patient has left sided neuroforaminal stenosis at l4-l5 and suggest that this could be the reason for the pain. But if you order a report and all you put is a vague symptom like general back pain (which a lot of you do), then i wll look at the image, noting several levels of degenerative changes and say " multiple levels of degenerative changes noted"..because degenerative changes do cause back pain. If you want to get a more accurate report TELL US WHAT SPECIFICALLY YOU ARE CONCERNED ABOUT'". dont send us a blind study. just like you get history from the patient when you are consulted, we need a history too. imagine if a person walked into the door and the ER doc said HISTORY: SICK, and tells you to admit the patient with no history. yes you might catch the obvious diseases(with labs, PE etc), but a lot of times, the history helps direct you.

my 2 cents

Sorry-- I wasn't trying to strike a nerve, just merely discussing our experiences with spine imaging and interpretations in our area. I certainly did not mean to suggest that ALL radiologists offer vague, generalized interpretations. The MSK-trained radiologists in our area are phenomenal at reading our imaging studies, but unfortunately they are only affiliated with the academic center. We deal predominantly with the private practice groups and imaging centers, who quite frankly seem more interested in the quantity of reads rather than the quality of them.

As for specifying what I want a study done for, I always ask specifically for what I believe is at the top of my differential. If I suspect a clinical left L4 radic, then it will be reflected in my order. If I suspect a pars fracture, it's in my order. What you may not understand from our end is that in chronic pain we see a huge volume of folks with "neck pain" and "back pain" that is very non-specific. Therefore, we often order imaging to assist with narrowing down our differential if history and exam are not helping us out much. These are the cases we expect a little more out of a radiologist than "degenerative changes." We look at these same films very closely and a majority of the time can locate a potential pain generator and treat it.

FWIW, "degenerative changes" means nothing to me as a pain physician. As I'm sure you know, a healthy 30 year old with no back/neck complaints likely has some component of "degenerative change."

I have several buddies from med school finishing their radiology residencies, and I know it's a lot of stuff to learn and master in a 5-year period. Again, wasn't trying to strike a cord, just describing our experience.

 

[p53]

For the person that asked why do a fellowship. Answer: To get a job. Private practice groups are large subspecialty type groups now. Radiology has changed alot in 5 years. A fellowship is needed to get a job. And doing a fellowship doesnt even guarantee a job. This is why many fellows are doing a 2nd fellowship in mammography or IR to get a job. Med students dont realize that if you include the PGY1 year you will be studying extremely hard for at least thru your PGY6 year to get a job. Plus radiology is not easy. The amount of reading is incredible and the board exams are the toughest in all of medicine. Just saying the truth.

 

[colbgw02]

As for specifying what I want a study done for, I always ask specifically for what I believe is at the top of my differential. If I suspect a clinical left L4 radic, then it will be reflected in my order. If I suspect a pars fracture, it's in my order. What you may not understand from our end is that in chronic pain we see a huge volume of folks with "neck pain" and "back pain" that is very non-specific. Therefore, we often order imaging to assist with narrowing down our differential if history and exam are not helping us out much. These are the cases we expect a little more out of a radiologist than "degenerative changes." We look at these same films very closely and a majority of the time can locate a potential pain generator and treat it.

Thank you for doing this, but please understand that you are the exception and not the rule. I read reports from other radiologists all the time, and a lot of the time I walk away thinking "huh?", so I can definitely appreciate what it's like to read a worthless imaging report.

On the other hand, I'd bet that at least 90% of the studies I read include insufficient, inaccurate, or simply no history. It's a huge joke in radiology, but it's pretty sad too. Sometimes we can recreate the clinical scenario if we have access to notes, labs, etc., but - again - that's a rarity in my experience.

In the worst cases, we do incomplete or incorrect studies, like when ortho ordered a knee MRI the other day for "patellar tendinopathy". Come to find out that the guy was s/p ACL recon with hardware in his knee. We would have done extra sequences on a different field-strength magnet if we had been given that history. But we're too busy to track down every ordering provider whenever we need more information, so we adopt the "garbage in, garbage out" approach.

While I can sympathize with getting garbage from an imaging report, it strikes a nerve with us when we hear a clinician complaining about not getting much information from the radiologists when we are so frequently handicapped by the converse.

 

[marcus pupil]

Sorry-- I wasn't trying to strike a nerve, just merely discussing our experiences with spine imaging and interpretations in our area. I certainly did not mean to suggest that ALL radiologists offer vague, generalized interpretations. The MSK-trained radiologists in our area are phenomenal at reading our imaging studies, but unfortunately they are only affiliated with the academic center. We deal predominantly with the private practice groups and imaging centers, who quite frankly seem more interested in the quantity of reads rather than the quality of them.

As for specifying what I want a study done for, I always ask specifically for what I believe is at the top of my differential. If I suspect a clinical left L4 radic, then it will be reflected in my order. If I suspect a pars fracture, it's in my order. What you may not understand from our end is that in chronic pain we see a huge volume of folks with "neck pain" and "back pain" that is very non-specific. Therefore, we often order imaging to assist with narrowing down our differential if history and exam are not helping us out much. These are the cases we expect a little more out of a radiologist than "degenerative changes." We look at these same films very closely and a majority of the time can locate a potential pain generator and treat it.

FWIW, "degenerative changes" means nothing to me as a pain physician. As I'm sure you know, a healthy 30 year old with no back/neck complaints likely has some component of "degenerative change."

I have several buddies from med school finishing their radiology residencies, and I know it's a lot of stuff to learn and master in a 5-year period. Again, wasn't trying to strike a cord, just describing our experience.

My apologies for being brash, it was a rough month in neuro. We even had a pain fellow rotating. Anyways, it is good that you give a history, most dont. I even got one the other day that said "evaluate" ! it is frustrating sometimes having to look stuff up on the medrec or calling the physician up... people have to understand, RADIOLOGY IS A BUSY FIELD. we are paid alot because of the sheer volume we read. essentially the entire hospital goes thru our eyes each day, and horsing around chasing physicians delays the publication of final reads....Thanks

 

[Goober]

I've got a friend from med school who is looking to graduate this upcoming year from radiology.

He told me that the market is a disaster. He has no fellowship, and can't find a job.

He reports that previous graduates who are now finishing fellowships are running into the same thing.

He is in the southeast..Is he simply not looking far enough, is he an idiot, or is he spot on?

Thanks in advance for responses.

I would not say it is a disaster. It is definitely tighter, but I would say the mid to late 1990s were much worse. In any case if he doesn't have a fellowship- there is something wrong because fellowships are not difficult to get. Specific fellowships and certain institutions are always tough, but as an overall difficulty of getting "any" fellowship- it is not the case. That is unless he failed to apply broadly enough or overestimated his chances.

Our group just filled a job position in a metropolitan area in the western US and honestly I thought we would get more and better candidates than the ones we had apply given the job market. There are jobs out there, you will definitely have to widen your geographic area of consideration. Expect lower salaries, longer partnership tracks or nonpartnership tracks, and the usual stuff that happens when the job market is tight.

 

[eddieberetta]

We see a huge volume of folks with "neck pain" and "back pain" that is very non-specific. Therefore, we often order imaging to assist with narrowing down our differential if history and exam are not helping us out much. These are the cases we expect a little more out of a radiologist than "degenerative changes." We look at these same films very closely and a majority of the time can locate a potential pain generator and treat it.

Of course you can. We can take 100 asymptomatic adults and I am sure we can find a potential pain generator in 90 (perhaps all 100 depending on their carrier). If you provide a targeted history we can look for OBJECTIVE and surgically treatable causes of pain i.e. see whether there is objective significant compression of NEURAL elements which may account for the symptoms. The other "pain generators" are NOT universally accepted, NOT well validated, and do not deserve more detail than the type of general overview of degenerative change that you feel is inadequate. In fact, you should be glad that these reports leave the door open for you to treat this "degenerative change" with the lucrative and not well-validated methods that comprise your specialty! We are not going to read your mind and state that the facet OA at L4/5 is marginally more than that at L3/4, but slightly worse than L5/S1 on the left, uh so I guess the patient needs facet injections at L1-L5...(bilaterally, q2weeks).......

What I can tell you is that you may understand degenerative / mechanical spine disease, but you do not have formal training in imaging, and even less so about imaging of non mechanical disease of the spine, disease of the spinal cord (neoplasms, vascular malformations, infections, inflammatory disease, etc etc) i.e. all the cases that NEVER come to you because of the radiologist's interpretation and referral. I put less than zero stock in your belief that you "read" degenerative cases better than radiologist x, because we all know that that there is very little agreement in this area between anyone! Only the cases that you never see (cord comp, tumors, vasc malfs etc) have a "right answer" interpretation -- that you would never need to make!

But we digress... the job market is much tighter, but there are still jobs out there. Must be flexible.